Wemyss Lodge

Wemyss Lodge is a residential care home registered to provide personal and nursing care for up to 60 people aged 18 and above with a wide range of support needs. At the time of the inspection 41 people were living at the home.

The care home had two separate units. One of these units was subdivided into three separate areas supporting 17 people. This unit specialised in providing care to people with more complex care needs including those living with dementia.

People’s experience of using this service and what we found

The home had made improvements since our last inspection which had been embedded into daily practice. This included improvements to medicines management and effective systems introduced to enable the provider to monitor and improve the service. Lessons were learnt and shared amongst the team, with a chance to reflect on practice.

Staff knew how to keep people safe and who to report to if they had concerns. There was confidence in the registered manager that they would take any concerns seriously and act upon them.

There was enough staff on duty, and they had been recruited safely and had the necessary skills and training to support people.

Risk assessment processes had improved. Care plans contained detailed risk assessments and management plans which ensured people received safe care. Medicines were managed safely by trained, competent staff.

The home worked well with health and social care professionals when needed.

Infection prevention and control procedures were robust, and the latest government guidance was followed regarding COVID-19.

There was a range of audits which checked, monitored and improved practices within the home. Relatives and staff told us they had confidence in the management of the home.

The provider worked to gain the views of the people living there and their relatives in order to make improvements. The registered manager and staff understood their role within Wemyss Lodge. Where necessary referrals had been made to external agencies including CQC.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 November 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wemyss Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Wemyss Lodge is a residential care home providing personal and nursing care to 46 people at the time of the inspection. The service is registered to support up to 60 people. The care home accommodates 33 people across the main building and 13 in a separate unit specialising in support for people with more complex needs such as mental health, brain injury and dementia.

People’s experience of using this service and what we found

At this inspection we found systems and processes in place were not effective in providing an overview of areas of the service that needed improvement. Systems in place had not identified the issues we found during the inspection.

Medicines were not always managed safely. Risks to people were not always assessed and managed effectively. Staff did not always receive effective training to ensure they had the skills and knowledge to meet people’s needs.

Staff provided mixed comments about the registered manager's approach. We raised this with the registered manager during the inspection.

People's and staff members views were sought but there was not always evidence these were used to help improve the service.

We received positive feedback from people’s relatives about the care and support their family members received at Wemyss Lodge. Comments included, “I’m thrilled with how they look after him. I’m so pleased with the attitude, care, and kindness of the care staff, all of them cleaners, office staff, carers”; “The staff we speak to all seem professional, caring, patient, they really do care about their residents” and “They are well informed, and they know about [person's] needs and personality. They know how to be with [person]. I know from talking to them that they know [person] as well as I do”.

We also received positive feedback from health and social care professionals that worked with the service to provide support and joined up care for people.

Relatives told us they felt their loved ones were safe living at Wemyss Lodge. Staff understood how to keep people safe from harm or abuse and understood their responsibility to raise concerns if they were to witness poor or abusive practice.

The provider had processes in place to ensure effective infection control and prevention during the Covid-19 pandemic.

The team worked effectively in partnership with other agencies to support people at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 10 January 2018).

Why we inspected

We received concerns in relation to the management of some areas of Wemyss Lodge including medicines safety and risks. We also received concerns about the manner in which the registered manager interacted with staff. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wemyss Lodge on our website at www.cqc.org.uk.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified two breaches in relation to the safe management of risks and medicines and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. If we receive any concerning information, we will use our current methodology to re-inspect the service.

Wemyss Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to accommodate and provide nursing care to up to 60 people. People are supported through individual care planning to meet a range of needs including living with dementia, physical disabilities and health conditions requiring nursing care and support. The home is located in a residential area of Swindon. On the day of the inspection, there were 46 people living at the service.

In March 2016, a comprehensive inspection identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not consistently delivered in a safe and effective way and there were not always enough staff to effectively meet people's needs. In addition, quality auditing systems were not identifying shortfalls in the service. We issued three warning notices to the provider, as a result of the concerns we identified and the service was rated as inadequate. The service was placed into special measures.

In October 2016, we completed a focussed inspection to ensure improvements had been made. We found the provider had taken the immediate action necessary to improve the service as required of the warning notices, however some improvements had not been sustained and further shortfalls were identified.

When we completed the last inspection in March 2017 we found some improvements. The management of medicines had improved although there were still areas which required improvement. Some risk assessments such as the 'Personal Evacuation Plans' did not contain sufficient guidance for staff on what support each person required and people who could not use their call bell had not been risk assessed to ensure they received timely and appropriate support. Improvements were required around the implementation of the Mental Capacity Act 2005 and how care records underpinned the Act.

In March 2017, we also found care records required improvement as they were not always person centred, lacked sufficient detail and information and records were not always accurate between the electronic system and the paper records. Audits were taking place, however improvements were required to ensure that there was an overview of the audits required and checks that these audits were being completed within the timescale set by the provider. Mandatory training as set by the provider had not been completed within the timescale required of the provider. Processes and systems were fragmented and staff did not always have a clear direction of leadership.

During the inspection in March 2017 we identified five breaches of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. We imposed a condition on the provider's registration to submit monthly audits to the CQC to ensure the quality of the service was being monitored.

At this inspection in December 2017 we found improvements had been made. People using the service told us they felt safe living at Wemyss Lodge. Relatives we spoke with agreed they were safe living there. People were kept safe from avoidable harm because the staff team had received training on safeguarding and understood their responsibilities. They knew what to look out for if they suspected that someone was at risk of harm and knew who to report their concerns to.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The risks associated with people's care and support had been assessed and reviewed. People received their medicines as prescribed. We have made a recommendation about the storage of some medicines.

Appropriate pre-employment checks had been carried out on new members of staff to make sure they were safe and suitable to work there. An induction into the service had been provided and on-going training was being delivered. This enabled the staff team to gain the skills and knowledge they needed in order to meet people's needs. There were sufficient staff to meet people’s needs and spend time with them.

People were provided with a clean and comfortable place to live. There were appropriate spaces to enable people to either spend time with others, or on their own.

Staff were supported through annual appraisals and a number of supervisions throughout the year. Staff told us that they felt supported by the registered manager and that communication was effective. Staff were aware of their duties under the Mental Capacity Act 2005. Staff obtained people's consent before carrying out care tasks. Legal requirements had not always been followed where people did not have the capacity to consent. We have made a recommendation that the provider consult with guidance to ensure consent is only given by those with the appropriate authority.

People who used the service and relatives consistently told us staff were caring, patient and upheld people's dignity. People felt consulted and listened to about how their care would be delivered. Care plans were personalised and centred on people's preferences, views and experiences as well as their care and support needs.

People who used the service knew how to complain, and who to. Complaints were investigated and responses given.

Auditing and quality assurance systems took place to monitor the quality of the service so that action could be taken where identified.

Wemyss Lodge is registered to accommodate and provide nursing care to up to 60 people. The accommodation is in single rooms with the exception of one double room. Wemyss Lodge has bedrooms on the ground and first floors. A passenger lift is available for people with mobility difficulties. There is a communal lounge and dining area on the ground floor with a central kitchen and laundry room. People are supported through individual care planning to meet a range of needs including living with dementia, physical disabilities and health conditions requiring nursing care and support. The home is located in a residential area of Swindon.

In March 2016, a comprehensive inspection identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not consistently delivered in a safe and effective way and there were not always enough staff to effectively meet people's needs. In addition, quality auditing systems were not identifying shortfalls in the service. We issued three warning notices to the provider, as a result of the concerns we identified and the service was rated as inadequate. The service was placed into special measures. Special measures provides a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

In October 2016, we completed a focussed inspection to ensure improvements had been made. We found the provider had taken the immediate action necessary to improve the service as required of the warning notices, however at this inspection we found some of the improvements had not been sustained and further shortfalls were identified. Insufficient improvement had been made to enable the service to come out of special measures.

Following the inspection in March 2017, the registered manager who was in post at the last inspection submitted an application to de-register. A new manager was recruited in November 2016. Both the current registered manager and the new manager were available throughout the inspection and the manager was in the process of registering with the Care Quality Commission, to become the registered manager.

During this inspection, improvements had been made to the service. The management of medicines had improved although there were still areas which required improvement. Where incidents had occurred the service were now including more detail in the incident forms in order to plan preventative care. Some risk assessments such as the ‘Personal Evacuation Plans’ did not contain sufficient guidance for staff on what support each person required and people who could not use their call bell had not been risk assessed to ensure they received timely and appropriate support.

People told us they felt safe living at Wemyss Lodge. Staff were confident when explaining what constituted abuse and were aware of the procedures to follow if required. Medicines were not always being managed in a safe way.

There were sufficient staff available to meet people’s needs. The numbers of staff required during the day and night had been reviewed and amendments made. Safe recruitment practices were followed to ensure new staff were suitable to work with vulnerable people.

People told us they liked the food and had enough to eat and drink. There were positive comments about the quality and variety of food. Staff gave people time and interacted in a friendly, caring and attentive manner. People’s rights to privacy and dignity were maintained.

Improvements were required around the implementation of the Mental Capacity Act 2005 and how the care records underpinned the Act. People received the support of health and social care professionals and referrals were made.

Staff were receiving supervision and training, however not in line with the provider policies. No appraisals had taken place, however these had been planned for 2017.

There was a range of activities people could take part in and this service continued to be developed around people’s specific needs. The home had undergone redecoration and was warm, welcoming with many sensory objects to illicit people’s interests.

Staff were kind and caring in their approach and improvements had been made in how they addressed and spoke with people. There were some practices which were institutionalised in their approach, such as wiping each person’s hands at the table.

Care records required improvement as they were not always person centred, lacked sufficient detail and information and records were not always accurate between the electronic system and the paper records.

Audits were taking place, however improvements were required to ensure that there was an overview of the audits required and checks that these audits were being completed within the timescale set by the provider.

The provider had sought the service of an external consultant who would continued to support the home with their auditing processes and development.

We found five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection was carried out to assess whether the provider had taken action to meet the warning notices we served. We will carry out a further unannounced comprehensive inspection to assess whether the actions taken in relation to the warning notices have been sustained, to assess whether action has been taken in relation to the three requirements and provide an overall quality rating for the service.

This report only covers our findings in relation to the warning notices we issued and we have not changed the ratings since the inspection in March 2016. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. You can read the report

from our last comprehensive inspection by selecting the 'all reports' link for Wemyss Lodge on our website at www.cqc.org.uk.

At this inspection we found that the provider had taken action to address the issues highlighted in the warning notices. Medicines were being safely managed and people were supported to take the medicines they had been prescribed. Staff kept good records of the medicines available in the home and the medicines people had been supported to take.

Chemicals for cleaning were safely stored and staff followed good infection control procedures. This helped to minimise the risk of injury and cross contamination.

Accidents and incidents were clearly recorded and action was taken to minimise future risks.

There were enough staff available to meet people's needs. Staffing was planned following regular assessments of people’s needs and was re-evaluated as people’s needs changed. One person we spoke with said they were happy with the staffing arrangements, commenting, “They come quickly when I use the call bell. There’s sometimes a bit of a wait at busy times, but it’s never too long”. Relatives told us they had seen improvements in staffing levels and said there were sufficient staff available to provide the care and support people needed. Comments included, “There has been a noticeable increase in staffing and I am always able to find staff when needed. Staff have clearly completed training on supporting people and communication and this has had an impact on practice”; and “There are enough staff available. I’m always able to get hold of someone when needed”.

The management team completed regular checks to assess how the service was operating. Improvements were made following these assessments and there was clear communication with people, their relatives and staff about the action being taken. Comments from relatives included, “I have seen huge improvements since the last inspection. (The registered manager) has been a driver of many of the changes”; and “The managers are very visible. You can always talk to them if there are any issues”.

Staff told us the management team had been very open with them about the changes that were needed and had provided them with clear direction. Comments from staff included, “Staff morale has improved. Very open management team, with clear communication. We feel like part of a team”; and “There is good support from the management. We are able to discuss any concerns and they will take action”.

Wemyss Lodge provides accommodation to people who require nursing and personal care. The home is registered to accommodate up to 60 people. On the day of our inspection, there were 57 people living at the home, some of whom were living with dementia. Wemyss Lodge has bedrooms on the ground and first floor. All rooms have an en-suite toilet and two bedrooms have access to a bathroom. There are five rooms which can be used for twin occupancy. A passenger lift is available for people with mobility difficulties. There is a communal lounge, large dining room and smaller dining room on the ground floor.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were not protected against the risk of unsafe or inappropriate care and treatment. Medicines were not organised and administered in a safe and competent manner and we found errors in the recording of prescribed drugs. Staff who administered medicines did not undertake an annual competency assessment to ensure they remained safe to administer medicines.

People were not protected against the risk of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. There was a lack of information and guidance for staff on how to support people safely and consistently.

Staff used unsafe moving and handling techniques which put people at risk of injury. Equipment was not appropriately checked to ensure it remained safe for people and staff to use.

Staff did not receive on-going support through a system of supervision and some staff had not received any supervision in 2015 and 2016. This included the clinical supervision of registered nurses. Appraisals were starting to take place in 2016. The trainer confirmed that mandatory training had fallen behind and they had recruited an additional trainer to support with this. Staff reported they felt supported and valued by the management team.

People told us they felt safe living at Wemyss Lodge and told us staff were kind and caring. We observed that staff were friendly towards people and most staff spoke to people in a respectful manner; however some staff practices and the language used when referring to people was not respectful.

There was a choice of drinks, snacks and meals available and people told us they enjoyed the food. The home had employed nutritional assistants to ensure people have sufficient hydration.

There were safeguarding and whistleblowing policies and procedures in place which provided guidance on the agencies to report concerns to. Staff had received training in safeguarding and whistleblowing to protect people from abuse and training records confirmed this.

There was a lack of audits in place used to assess, monitor and improve the quality, safety and welfare of people. Required audits such as in controlled medicines and infection control were not carried out. Gaps and shortfalls in the service provision were not identified. The registered manager did not have an overview of how the home was being managed and who had responsibility for various elements of this.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2015. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘Inadequate’. This means that this service has been placed into ‘Special measures’ by CQC. The purpose of special measures is to: Ensure that providers found to be providing inadequate care significantly improve. Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We spoke with the registered manager, deputy manager, deputy matron, training officer and four care and/or nursing staff. We spoke with five people who use the service and the relatives of four people. We reviewed six people's care plans and records related to the management of the service, including staffing and quality assurance records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. People's care plans included information about any risks to people's health, safety and welfare. Records showed risks were assessed and actions identified and carried out to minimise risk. The registered manager reviewed incidents in the home and took action to prevent reoccurrence. The premises were safe, well maintained and suitable for the needs of people being supported.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications submitted by the provider followed the correct procedures and were properly authorised. At the time of our inspection the provider was in contact with the local authority DoLS service to discuss changes in response to a recent Supreme Court judgment. We were assured a review of people's needs would be completed following our inspection to ascertain if other applications were required. This meant the provider was taking appropriate action to ensure the human rights of people using the service were protected.

Is the service effective?

People told us they were satisfied with the care they received and felt their needs had been met by sufficient numbers of staff. It was clear from what we saw and from speaking with staff that they understood people's care and support needs. One relative told us how their relative had been supported to make improvements in their health. Another relative said: "It's hard to entrust a loved one to care, I have peace of mind because they take great care of my relative and they do an excellent job I couldn't wish for a better home". A person said: "I think it's brilliant, I am cared for very well". Staff received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw staff were patient and gave encouragement and reassurance when supporting people with care and when distressed. A relative said: "When I am not here I have peace of mind because I know my relative is well looked after, they genuinely care". A person said: "staff are very nice and I feel I can talk to them." People confirmed they were offered choices and involved in their care and treatment.

Is the service responsive?

People's needs had been assessed before they moved into the home and care was reviewed and adapted to meet their changed needs. Records confirmed people's preferences and abilities had been recorded and care and support had been provided that met their wishes. People's healthcare needs were met by trained nurses in the home and by other healthcare providers as required. Complaints were responded to and people told us staff listened to them. One relative said: "When you ask them something they get back to you straight away."

Is the service well led?

Quality assurance processes were in place. This helped to ensure that people received a good quality service. Staff we spoke with told us they were well supported by their managers and senior staff. A staff member said: "I can talk to any of the managers if there is a problem they sort it out straight away, they take care of residents and staff safety". Records showed people and their relatives were asked for their feedback on the service and their comments were acted on. Staff views were taken into consideration in the quality of the service and people's care and treatment.

The home provided a varied and nutritious diet and promoted choice. The home took steps to monitor health issues and were thorough in their management of pressure care.

All staff were required to complete training on adult protection and were made aware of their responsibility to report concerns. People who lived in the home and relatives we spoke with told us they thought the home was a safe place to live.

Staff were provided with regular training.

The home ensured that all equipment in use was correctly serviced and maintained which promoted peoples safety.

People said they enjoyed the activities that were organised and had a choice as to whether to participate or not.

We found that the home was clean and hygienic throughout and that there were systems in place for maintaining these standards.

We found that the home had safe and effective procedures in place to recruit staff.

The home had the correct procedures in place to safely store and administer medication. Appropriate training in this area was provided for staff.